Harris R E, Wynder E L
American Health Foundation, New York, NY 10017.
JAMA. 1988 May 20;259(19):2867-71.
A total of 1467 cases of women with breast cancer and 10,178 sex- and age-matched hospital controls were examined for alcohol consumption and other potential risk factors. Effects of risk factors were assessed by odds ratios, and adjustment was made for confounding variables by using stratified analyses and logistic regression. Several factors were found to influence alcohol consumption, including age, religion, education, occupation, marital status, body mass, and cigarette smoking. Lean women (Quetelet index, less than 22) had elevated unadjusted odds ratios for breast cancer of 2.10, 1.71, and 1.41 associated with consuming less than 5, 5 to 15, and more than 15 g of alcohol per day, respectively. However, this pattern is not consistent with a dose response, and adjustment for a risk profile of confounding factors, including education and occupation (which are strong correlates of age at first pregnancy and parity), reduced these estimates to 1.40, 1.24, and 0.87, none of which differs significantly from 1.0. Among all subgroups, the odds ratios adjusted for pertinent confounders and interactions fluctuated randomly about 0.94 and showed no consistent trend with increasing alcohol consumption. While these results do not entirely rule out a weak association between breast cancer and alcohol in certain subgroups, neither do they provide compelling evidence that alcohol has a role in the genesis of this malignancy.
对1467例乳腺癌女性患者和10178例年龄及性别匹配的医院对照者进行了饮酒情况及其他潜在风险因素的检查。通过比值比评估风险因素的影响,并使用分层分析和逻辑回归对混杂变量进行校正。发现有几个因素会影响饮酒情况,包括年龄、宗教信仰、教育程度、职业、婚姻状况、体重和吸烟。瘦女性(奎特利指数小于22)每天饮酒量少于5克、5至15克和超过15克时,未经校正的乳腺癌比值比分别为2.10、1.71和1.41。然而,这种模式不符合剂量反应关系,对包括教育程度和职业(这两者与初孕年龄和产次密切相关)在内的混杂因素风险概况进行校正后,这些估计值分别降至1.40、1.24和0.87,均与1.0无显著差异。在所有亚组中,针对相关混杂因素和相互作用进行校正后的比值比在0.94左右随机波动,且未显示出随饮酒量增加的一致趋势。虽然这些结果并未完全排除在某些亚组中乳腺癌与酒精之间存在微弱关联,但也没有提供令人信服的证据表明酒精在这种恶性肿瘤的发生中起作用。